became available in 1992. Today, blood transfusions are considered safe. Healthcare workers may be exposed to HBV through needle sticks and other accidental exposures on the job.
Hepatitis B may be transmitted through sexual activity. HBV is much more likely than hepatitis C virus (HCV) to be sexually transmitted. The CDC estimates that 30-60% of new hepatitis B virus infections may be acquired through sexual contact.
Treatment
There are currently two types of drug treatments for chronic hepatitis B: interferon and antivirals. Several other drugs are under study. Research suggests that one day, combination treatment may be more effective than single drugs used alone (monotherapy).
Most people chronically infected with hepatitis B do not require treatment. These people should, however, have their ALT (amount of an enzyme in the blood) levels and overall health monitored by a physician regularly (at least every 6 months).
Prevention
In addition to the use of universal precautions, HBV can be prevented with a vaccine. There are currently 2 HBV vaccines available, Energix-B and Recombivax HB. For adults, the vaccine is administered as a series of 3 injections given over 6 months, the second injection 1 month after the first, and the third one 5 months later.
A 2-dose vaccine has been approved for adolescents aged 11-15. A combination HAV/HBV vaccine (Twinrix) is also available. The hep B vaccine is highly recommended for healthcare workers, sexually active adults, injection drug users, household contacts of hepatitis B-infected individuals and people infected with hep C. Today, the hepatitis B vaccine should be part of the standard infant vaccination series, and may also be given to adolescents who were not vaccinated as infants or children.
HEPATITIS C
Hepatitis C (HCV) is the most prevalent liver disease in the world with150 million chronic infections. In 2014, a total of 2,194 cases of acute hepatitis C were reported to the CDC from 40 states in the US. The overall incident rate for 2014 was 0.7 cases per 100,000 people; an increase from 2010-2012. After adjusting for under ascertainment and under-reporting, an estimated 30,500 acute hepatitis C cases occurred
in 2014. An estimated 2.7-3.9 million people in the United States have chronic hepatitis C. The World Health Organization (WHO) considers hepatitis C a worldwide epidemic. Because hepatitis C can infect a patient for decades before being discovered, it is often called the “silent” epidemic.
According to the Centers for Disease Control, 20-30%
of people with chronic hepatitis C will eventually face life- threatening symptoms
Transmission
Hepatitis C virus is spread primarily by direct contact with human blood. For example, you may have gotten infected with HCV if you:
• ever injected street drugs. The needles and/or “works” used for preparation or injection may have been contaminated with someone else’s blood.
• received blood, blood products, or solid organs from a donor whose blood contained hepatitis C.
• were on long-term kidney dialysis, as you may have unknowingly shared supplies or equipment that had contaminated blood on them.
• were ever a healthcare worker and had frequent contact with blood on the job, especially accidental needlesticks.
• were born to a mother had had hepatitis C at the time of your birth. During birth, her blood may have mixed with yours.
• ever had sexual contact with a person infected with HCV.
• shared items with someone who was infected with HCV, such as razors or toothbrushes that might have had his/her blood on them.
Treatment
Combination therapy with interferon and ribavirin has been the treatment of choice resulting in sustained response rates of 40%-80%. The FDA has recently approved a new drug called INCIVEK™ (telaprevir). This new prescription medicine is used with the drugs peginterferon alfa and ribavirin to treat chronic hepatitis C genotype 1 infection in adults. Treatment length is quite long (about 48 weeks), but the results are nothing short of amazing.
Interferon monotherapy is generally reserved for patients in whom ribavirin is contraindicated. Ribavirin, when used alone, does not work. Combination therapy using interferon and ribavirin is now FDA approved for use in children aged 3-17.
The Basics 12
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